Basic Information
| Provider Information | |||||||||
| NPI: | 1326060443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LODHAVIA | ||||||||
| FirstName: | PARAG | ||||||||
| MiddleName: | JITENDRA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 302 POLK AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199631818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024223393 | ||||||||
| FaxNumber: | 3024226875 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 POLK AVE | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199631818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024223393 | ||||||||
| FaxNumber: | 3024226875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 06/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C1-0007287 | DE | Y | Other Service Providers | Specialist |
No ID Information.